HEALTH IT AND HEALTH DISPARITIES
Patient Provider Telehealth Network – using telehealth to improve chronic disease management
PREPARED FOR: U.S. Department of Health and Human Services Washington, D.C.
PREPARED BY: NORC at the University of Chicago 4350 East-West Highway 8th Floor Bethesda, MD 20814
JUNE, 2012 CONTRACT NUMBER: HHSP2337005T/OS38984
This report was prepared by NORC at the University of Chicago under contract to the Office of the National Coordinator for Health IT (ONC) and the Health Resources and Services Administration (HRSA). The findings and conclusions of this report are those of the authors and do not necessarily represent the views of ONC, HRSA, or the U.S. Department of Health and Human Services.
NORC | Understanding the Impact of Health IT in Underserved Communities and those with Health Disparities
Case Study Report: Patient Provider Telehealth Network – using telehealth to manage chronic disease
“This program is different from other programs. We always hear from patients, ‘This was the first time anyone has cared enough to help me figure it out.’ This health IT program is about longer-term relationship building and working with the patient to give them the encouragement that they can do this and make the associations.” – RCCHC Provider Report Summary Members of the NC-based Patient Provider Telehealth Network use a telehealth remote Intervention monitoring system to monitor key health indicators for rural, high-risk patients throughout the and Setting state. Members leverage their electronic health records (EHRs) to share data collected through remote monitoring devices with patients’ providers. Target Uninsured or underinsured high-risk individuals with diabetes, cardiovascular disease, and Population hypertension Technology Software-based telehealth remote monitoring systems and corresponding health indicator Description measure devices. Phase 1 (2006 – 2009): NC Health and Wellness Trust Fund Commission ($360,000) in 2006; additional funding (2007-2009) from Kate B. Reynolds Charitable Trust, the Obici Foundation, Pitt County Foundation, and the Roanoke Chowan Community Benefit to expand Funding RCCHC’s remote monitoring program and implement a post discharge remote monitoring and and Start- chronic care management for diabetes patients at Roanoke Chowan Hospital. up Phase 2 & 3 (2009 – present): NC Health and Wellness Trust Fund Commission ($870,000); Funding (amount unknown) from Duke Endowment to continue in-house at Piedmont (2010). Health Resources and Services Administration (HRSA) Telehealth Network Grant (2010 – present): $250,000 Content analysis using NVivo for a series of in-person discussions with the following individuals from Roanoke Chowan Community Health Center (RCCHC) and Piedmont Health Services, Inc. (Piedmont): RCCHC and Piedmont Chief Executive Officers and Chief Medical Officers Data and RCCHC Telehealth Clinical Network Director Analysis Piedmont Director of Care Management (Telehealth Administrator) Piedmont Director of IT RCCHC and Piedmont physicians, registered nurses, and care managers Individuals who obtain services from RCCHC and Piedmont clinics Introduction of health information technology (health IT) tools through a trusted source is fundamental to successful adoption. Key Take- Remote monitoring can dramatically increase patient engagement and result in improved Aways outcomes for chronic disease self-management and reductions in hospital-related costs. Interoperability with other IT systems and reimbursement for telehealth care are critical to further adoption and sustainability.
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Introduction A Federally Qualified Health Center (FQHC) located in rural northeastern North Carolina, Roanoke Chowan Community Health Center (RCCHC) operates clinics in Ahoskie, NC, Colerain, NC, and Murfreesboro, NC. As one of the only health care providers in the area, RCCHC currently provides care to approximately 21,000 individuals, more than half of the patients in the service area. The RCCHC serves a primarily Black population (70%) with a high chronic disease burden and very low incomes.i Their service area includes four of the poorest counties in the nation. One program administrator estimated 20% of RCCHC patients live 100% below the Federal Poverty Level (FPL)ii and the majority of the patients served have no or inadequate insurance. In 2006, RCCHC received Phase I grant funding from the NC Health and Wellness Trust Fund (HWTF) Health Disparities Initiative to conduct a three-year feasibility study of the center’s Patient Provider Telehealth Network (PPTN). The study sought to determine the impact of telehealth monitoring on clinical and financial outcomes for RCCHC’s patients with cardiovascular disease, diabetes, and hypertension. In 2008, the PPTN expanded to provide remote monitoring services to patients enrolled in Piedmont Health’s (Piedmont) PACE program (Program of All Inclusive Care for the Elderly). Piedmont, also an FQHC, operates six clinics – two semi-urban and four rural – serving patients across 14 counties. The clinics operate in Carrboro, NC, Moncure, NC, Prospect Hill, NC, Siler City, NC, and two locations in Burlington, NC. Piedmont provides care to largely uninsured or underinsured patients. One provider reported 76% of patients live at or below 100% of the FPL and an additional 20% live at or below 200% of the FPL. Piedmont primarily serves members of racial or ethnic minority groups. Hispanics make up approximately half of their population and Blacks make up an additional 20%. Piedmont administrators also noted a growing Burmese population. In 2010, Piedmont received funding to self-monitor their patients previously monitored by RCCHC. Between 2009 and 2010, the PPTN expanded to eight additional health centers and two hospitals as a result of additional funding received from the HWTF Health Disparities Initiative and a telehealth network grant from the Health Resources and Services Administration (HRSA). As of early 2011, RCCHC monitored and managed patients across 28 – primarily rural – counties in North Carolina.iii Rural populations and rural minority populations in particular, experience marked disparities in health and health care access. Compared to providers in strictly urban areas, rural health care providers serve an older and poorer population and a population more likely to experience fair or poor health and chronic conditions. According to the Agency for Healthcare Research and Quality (AHRQ) 2010 National Healthcare Quality and Disparities Report, rural residents do not receive recommended preventive services at the same rate as their urban counterparts and on average report fewer visits to health care providers.iv Potential benefits of using telehealth remote monitoring technology. Use of telehealth remote monitoring technologies can improve clinical management of chronic diseases, increase cost- savings, and expand access to quality health care services. Many telehealth interventions demonstrate utility as a health care delivery tool for underserved populations in rural communities where geographic distance and lack of specialists pose challenges to traditional delivery of health services.v The application of telehealth technologies enables earlier detection and quicker assessments using evidence- based health information.vi Earlier recognition of health problems promises to improve quality and cost- efficiency of care through decreased emergency department (ED) visits and hospital readmissions. Additionally, as demonstrated at RCCHC and Piedmont, programs using telehealth technology improve CASE STUDY: Patient Provider Telehealth Network| 3 NORC | Understanding the Impact of Health IT in Underserved Communities and those with Health Disparities patient engagement and self-management to foster increased adherence to treatment plans through patient education. Key functionality and uses. RCCHC and Sources of Funding Piedmont use several remote monitoring applications Phase 1 (2006 – 2009): NC Health and as part of the PPTN. Currently in use for Phase 2 is Wellness Trust Fund Commission ($360,000) in IDEAL LIFE’s Body Manager, a software-based 2006. Additional funding (2007-2009) from: telehealth system, which includes a digital body o Kate B. Reynolds Charitable Trust, weight scale and blood pressure device. Placed in o The Obici Foundation, participating patients’ homes, the IDEAL LIFE o Pitt County Foundation, and remote monitoring telehealth system transmits daily o Roanoke Chowan Community Benefit readings from patients’ blood pressure and scale Phase 2 & 3 (2009 – present): NC Health and devices as encrypted data through landline or cellular Wellness Trust Fund Commission ($870,000); connection platforms to the IDEAL LIFE secure web o Funding (amount unknown) from Duke server. Telehealth nurse care managers monitor Endowment to continue in-house at patients’ data via the system’s dashboard and contact Piedmont (2010) patients with abnormal readings via phone to conduct HRSA Telehealth Network Grant (2010 – a nursing assessment and/or provide patient present): $250,000 education. The monitoring dashboard allows care managers to create summary reports and trend patient data longitudinally. As part of the PPTN, if a telehealth care manager determines there is need for a change in a patient’s medical regime during the nursing assessment, they can share the health data collected through remote monitoring technology via the respective center’s electronic health record (EHR) to alert the patient’s primary care provider of the possible need for further medical intervention. Table 1 below summarizes the telehealth remote monitoring applications and EHRs utilized by RCCHC and Piedmont.
Table 1: Overview of Telehealth Remote Monitoring and EHR IT at RCCHC & Piedmont Health Description of Functionality IT
Phase 1 (2006 – 2009) - WebVMC’s RemoteNurse, a software-based telehealth remote monitoring system, supported a landline (phone or internet) platform for connectivity. Transmitted vital sign readings from a scale, blood pressure monitor, glucose monitor, and pulse oximeter via a secure server. The system also transmitted data from patients’
responses to verbalized and written assessment questions (available in English and Spanish) regarding health status and function to RCCHC’s corporate server. - WebVMC’s telehealth kiosks were installed at three Senior Citizen Wellness Centers, a church with a Spanish- speaking congregation, and a middle school. Users received a magnetic card to uniquely identify them to kiosk software. Kiosks captured vital signs information (blood pressure, pulse, weight, and blood glucose). - PHILIPS Health Buddy remote monitoring devices with peripherals for scale, blood pressure meter, glucose meter, and pulse oximeter. Phase 2 (2009 - present) - IDEAL LIFE’s Body Manager, a software-based remote monitoring system, supports land-based and wireless (cellular) platforms for connectivity. The system transmits encrypted vital signs data from a digital body weight scale and blood pressure devices to the IDEAL LIFE secure web server. - PHILIPS Health Buddy remote monitoring devices with peripherals for scale, blood pressure meter, glucose Telehealth Remote Monitoring Applications Core Health IT Technologies Health Core meter, and pulse oximeter. RCCHC • GE Centricity/Logician EHR (date unknown); EPIC EHR implemented in 2005 Piedmont
EHRs • GE Centricity EHR implemented in 2007 with registry and quality reporting functionality
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Encouraging Adoption & Implementation We begin by outlining findings related to the implementation and adoption of telehealth at RCCHC and Piedmont, including discussants’ assessments on lessons learned from their experience.
Effective provider adoption requires feedback and “I think that there is big customization. RCCHC leadership reported provider input during problem with implementing the design stage of the telehealth project paved the way for broader out of a box – there are a lot of provider acceptance during program rollout. RCCHC administrators barriers. Fortunately, we were closely involved in the project development explained care managers able to alter and shape [the constantly sought providers’ feedback during the design phase in software] to a form we order to ensure the program met providers’ clinical needs and wanted.” RCCHC Administrator expectations. RCCHC respondents noted input from providers greatly contributed to the development of the care plan and summary report templates. Ultimately, RCCHC designed the program to align with provider workflow and to leverage EHRs in both clinics to send providers summary clinical indicator reports on their patients. Some Piedmont stakeholders thought including trend data as part of the summary reports would improve usefulness. Additionally, to allow enhancements over time, both RCCHC and Piedmont administrators stressed the importance of selecting a vendor that permits ongoing customization as providers learn more about how to address the needs of their population.
Patients and providers adopt technology more readily when a trusted source introduces and encourages its use. Piedmont and RCCHC stakeholders noted the importance of using a trusted source to facilitate both patient and provider adoption of telehealth. With regard to provider adoption, administrators from RCCHC emphasized the importance of using a physician champion to introduce the program to Phase 2 partner clinics. As described by a RCCHC administrator: “One of the doctors is our champion and when we go out to talk to other health centers… it is doctor to doctor, which we learned makes a difference.” Likewise, Piedmont providers indicated the RCCHC physician who introduced the program eased some of their concerns related to adoption and implementation.
Having a trusted human component to introduce and facilitate the use “It’s the initial hesitation of telehealth technology provided important support for patient toward technology in that they’ve never had anyone acceptance and adoption of telehealth. One RCCHC provider empower them to do it on their attributed the program’s success to the role of the trusted surrogate. own before. Here is the doctor Reflecting on the program’s rollout, a RCCHC patient said, “I like empowering them and saying, that [the telehealth care managers] are warm people when they enter ‘Here is a good program for your home. They don’t talk down to me like I’m not taking care of you and something you can do myself… and I like that.” Similarly, Piedmont staff felt that on your own to help you own health.’” Piedmont Stakeholder incorporating case management monitoring responsibilities “in- house” at their primary clinic rather than remotely through RCCHC increased the program’s effectiveness allowing them to build upon local relationships between patients and case managers that develop during patients’ medical visits at the clinic. Reflecting on this belief, one RCCHC administrator said, “It didn’t work as well [when RCCHC monitored from Ahoskie] because the [RCCHC] nurses didn’t have the same type of relationship with the patients and providers; it was much chunkier.”
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In addition to case management outreach, provider driven outreach encouraged patient use of the telehealth technology. Multiple RCCHC and Piedmont patients cited encouragement from their primary care provider as their reason for agreeing and continuing to participate in telehealth. RCCHC administrators noted provider commitment to adoption reinforced the importance to patients, subsequently increasing their acceptance of the technology.
Case demonstrates acceptance of remote monitoring technology among users who are not regular computer users. Case study respondents agreed that despite “Our population never their overall limited use of computers and mobile devices in their thought of technology as a everyday lives, patients willingly embraced the telehealth technology. barrier. You teach it as a tool Expecting greater resistance from patients, care managers expressed for you and your doctor. surprise at patients’ acceptance of the program. Both clinics reported Making sure they understood very few patients declined to participate in the program despite you aren’t an equipment limited use of computer technology; RCCHC and Piedmont patients agency and that this is what your doctor wants you to did not express privacy concerns related to the electronic transfer of do.” RCCHC Administrator personal health information because of the benefits and peace of mind afforded by the monitoring program.
Impact and Consequences Having explored strategies used by RCCHC and Piedmont to implement telehealth, we next describe how they employed the tool to address the needs of its target population.
Reported increased access to information for providers and improved decision-making. Providers found telehealth offered increased access to information that helps inform their decisions, leading to improvements in provider efficiency and overall quality of care. Both Piedmont and RCCHC providers indicated they use the telehealth summary reports available through their EHRs during patient encounters. Commenting on improvements in efficiency, a RCCHC provider said, “It makes the visit more focused. Instead of going in and saying, ‘Tell me about your blood sugars,’ it’s more like, ‘I see your blood sugars are here, let’s talk about these days.’ It helps me to be more focused because the data is there.”
Telehealth allowed providers and care managers to better “It’s given me a little more confidence about whether I understand the full spectrum of challenges faced by their patients ought to change something on and helped them assist patients in more ways. Care managers the basis of what I’m seeing in recalled a number of instances when they quickly connected with the office only. It’s another tool individual patients to address the cause of fluctuations detected by with more data to help make the telehealth remote monitoring applications and subsequently informed decisions. It’s set up identified solutions to practical factors affecting the patient’s ability so that it doesn’t give me data overload.” RCCHC Provider to maintain good health. Providers also indicated the telehealth summary reports allowed them to make better clinical decisions related to patient medication. One RCCHC provider explained, “[The telehealth summary reports] certainly help me figure out medications more quickly. We allow ourselves to be less aggressive when we only get a blood pressure in the clinic (which may be artificially elevated due to white-coat effects), so it has helped me to get a clearer sense of what is going on.”
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Telehealth remote monitoring facilitates patient engagement and access to care, and results in “I thought…how was this big ‘ol machine improved self-management of chronic disease. sitting on the kitchen table that [the care All RCCHC and Piedmont stakeholders strongly manager] brought in gonna help? With everything I do, now I gotta get up every agreed telehealth remote monitoring dramatically morning and get on that scale… and you improved patient engagement, resulting in gonna know how much I weigh? What if I want improvements in patients’ access to care and self- a hamburger or donut or something like that? management of chronic conditions. Remote But… like I said before, it really helped me. I monitoring motivated patients to take an active role in knew [the case manager] was watching my improving their health and further developed their weight… so what am I gonna do? I’m gonna relationship with their care managers and providers. curb my eating of donuts, cheeseburgers, honeybuns, Pepsi-colas and all that good A number of patients indicated they felt empowered stuff.” RCCHC Patient to make healthier decisions because their providers were “watching them” and “paying attention.” As described by one Piedmont patient, “It has changed my relationship with the doctor. It is nice to know that he has the readings so it doesn’t feel like we’re starting with zero. If the readings alter… I talk to him.”
Related to improved relationships with providers, patients frequently mentioned that their participation in remote monitoring and relationship with the care managers increased their access to their respective providers at RCCHC and Piedmont, as well as with other providers and health care services in their communities. One patient explained, “Because of [the care managers’] access to different services that I might need, they can tell me where I can access it or what places might have it. If I have a problem with something I can call and my questions are always answered within a day… They communicate with my other doctors and helped me when I couldn’t afford my medication.”
“One of the main components is teaching the Telehealth also led to improvements in health literacy patients to self-manage their disease and education, which coupled with improved patient process. With the low literacy and low engagement, facilitated better patient self- income population we work with, we went management. One case manager provided the into the process thinking there were going to following anecdote to describe observed be a lot of barriers in educating. But the improvements in patient management of their health: reality is that educating and communicating with them about weight [using remote “Patients come to the clinic and say, ‘Man, I had monitoring telehealth] – they are getting it. Campbells [soup] and my blood pressure was Before they didn’t realize that they were horrible.’ They have started to notice the trend in their eating all this pork and it wasn’t good [for diet and the effects the next morning… I have seen a their blood pressure]. ” RCCHC Administrator huge difference in their behavior because of this.”
Significant improvements in health outcomes and reductions in hospital-related costs. The evaluation of Phase 1 of the telehealth project, conducted by Wake Forest University (Wake) and East Carolina University (ECU) revealed significant improvements in blood pressure and cost savings related to hospital bed days and (ED) visits.vii,viii,ix The evaluation of Phase 2 is currently underway. Researchers observed statistically significant improvements in blood pressure at five points in time (from baseline – six months prior to telehealth – through three years post-intervention). x The analysis did not show significant changes in weight gain or hemoglobin A1c (HbA1c), however, patients and providers generally felt that the health of patients who received telehealth remote monitoring had improved compared to the baseline. As described by one patient, “I’m walking 30 minutes on the treadmill now. At
CASE STUDY: Patient Provider Telehealth Network| 7 NORC | Understanding the Impact of Health IT in Underserved Communities and those with Health Disparities first I did 10 minutes and I was out of breath. I had asthma attack in 2007 and I couldn’t walk to my mailbox without losing breath, but now I’m walking 30 minutes on the treadmill!”
Comparing baseline (six months prior to telehealth) to the intervention period (six months during telehealth) researchers observed a 50% reduction in hospital bed days and an 81% reduction in ED visits. These reductions continued after telehealth as subsequent analyses showed a 65% reduction in hospital bed days and a 15% reduction in ED visits when comparing baseline to post-intervention (six to thirty months post telehealth). These significant reductions in hospital-related outcomes resulted in significant hospital cost reductions during telehealth (72% cost reduction) and post-telehealth intervention (64% cost reduction.)xi Anecdotal evidence provided by a Piedmont patient supports these findings: “I’ve been to the hospital a couple of times because of body fluid. I think [telehealth] kept me out of the hospital.”
Barriers to Use of Technology While the case study presented several positive findings relative to telehealth implementation, we identified some notable barriers of relevance to similar projects. We discuss some of these barriers below.
Liability concerns challenge provider adoption. Provider concerns surrounding liability initially presented “In the contract we say we will monitor Monday through Friday… well, people get a barrier to provider adoption and use of the program. sick Saturday and Sunday too. During the RCCHC and Piedmont largely addressed this concern week when the clinic is open, if they’re not with comprehensive protocols and strict standards of feeling well they can call the telehealth care; however, some providers expressed initial hesitation nurse directly and reach her. But on towards the program. They worried about an expectation Saturday and Sunday, the days we’re not to incorporate a huge volume of new information from typically monitoring, we say that if you aren’t feeling well – call us – but that puts telehealth into their day-to-day decision-making – an the telehealth nurse in limbo. She’s not expectation that they may not have the resources to meet. obligated to answer on Saturday and One program administrator summarized this concern, Sunday so we feel a little liable... This isn’t explaining, “Once you have the information and you’re 24-hour monitoring…” not doing something with it, then there is a problem.” Piedmont Administrator
RCCHC staff also expressed concerns surrounding Phase 2 because they could not guarantee review or use of the telehealth data for clinical decisions by partner providers. Providers generally appreciated having data collected through telehealth monitoring, but acknowledged liability concerns could arise if they did not have the resources to respond appropriately.
Interoperability would improve usefulness. Lack of “As the patient information comes back to the website, it needs to be moved interoperability with other electronic record systems at both into the EHR. At this phase, we’re still RCCHC and Piedmont limited the utility of the IDEAL doing that manually. We looked at LIFE software. Due to high cost, an interface between doing a bidirectional interface between IDEAL LIFE and both Piedmont’s and RCCHC’s EHRs IDEAL LIFE and [GE] Centricity but it does not currently exist, thus staff manually copy all alert- turned out to be a tremendous amount related information from the IDEAL LIFE software into of work for a – at this point – very small number of patients. I couldn’t justify patients’ electronic records. One Piedmont administrator using our resources for the interface.” explained, “We worked with IDEAL LIFE to integrate it into Piedmont Administrator our EHR. At first we thought it would be easy and wouldn’t cost a lot but now it’s looking like it’s not going to happen
CASE STUDY: Patient Provider Telehealth Network| 8 NORC | Understanding the Impact of Health IT in Underserved Communities and those with Health Disparities due to technical and financial barriers… Right now we have a poor man’s way of integrating… the telehealth nurse is copying and pasting the reporting [data] into the EHR, which is time intensive.” Staff noted the usefulness of patient alerts and summary reports but indicated the need to filter the information to remove “dumb data,” which creates a burden for all care providers. While stakeholders at both sites want to pursue an interface between IDEAL LIFE and their respective EHRs, they lack the necessary funding to do so.
Infrastructure and financial constraints limit access. Stakeholders identified financial and infrastructure constraints, “A lot of these people don’t have home phones… we’ve specifically in access to a phone jack, internet connection or cellular switched from an era of all service, as barriers to patient participation in telehealth. Many people having home lines to patients found it challenging to consistently participate in the one where most people have a program due to limited resources. Care managers at both sites cell phone most of the time… explained patients do not always have the financial means to pay that is a challenge for follow-up for telephone or internet bills. While the IDEAL LIFE software monitoring, especially within our population. That is still a enables communication via cellular technology, care managers gap we’re missing based on noted patients frequently purchase prepaid phones with plans that socioeconomic status.” limit minutes of airtime and data use. The use of prepaid phones Piedmont Telehealth Care also makes it difficult for telehealth staff to track patients since Manager phone numbers frequently change.
Respondents noted the lack of cellular coverage in many of the rural communities also constrains patient access, especially because many homes in rural areas do not come equipped even with landline phone jacks or electricity. As one Piedmont telehealth nurse explained, “I’ve got one patient who, like most of my patients, lives out in the country… [phone] service is a problem… his house only has one power outlet and doesn’t have a phone jack. There were issues with getting a phone jack installed... I tried with the cellular device but it doesn’t work. [Cellular carrier] doesn’t work out there… I tried everything. This guy really wants [telehealth] and needs it but I can’t get the cellular device to work at his house.”
Policy and Organizational Factors for Replicability Finally, we present key findings related to organizational and policy factors that played an important role in the implementation and adoption of telehealth, particularly as they relate to replicability.
The reimbursement environment in a state can drive sustainability. Although RCCHC received funding to “Being an FQHC… it would be great if we could begin to bill for in-home successfully implement and expand the PPTN into a third telehealth monitoring just because it phase, major financial barriers limit sustainability and further requires several FTEs (full time project development. Both RCCHC and Piedmont staff equivalent units) – care management, identified the realignment of reimbursement policies for a nurse, and in so many other arenas telehealth as critical for sustainability. Staff emphasized a to supervise. Providers are making need for reimbursement policies that recognize the value of decisions based on telehealth outcomes data …” investments in telehealth equipment and expertise as a way Piedmont Administrator to spread the use of telehealth by reducing out-of-pocket costs and encouraging buy-in among care providers.
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Partnerships can provide functional support. RCCHC’s and Piedmont’s strong community partnerships demonstrate the importance of mutually beneficial collaborations in enabling program success. Partnerships with regional medical centers allowed both health centers to obtain data from community hospitals on PPTN program participants. Access to these data enabled clinics to document the impact of the program on hospital-related outcomes and costs. Additionally, program administrators indicated partnerships with numerous academic institutions, namely Wake and ECU, gave critical credibility to the data evaluation piece of the project. Lastly, the centers’ partnership with IDEAL LIFE illustrates the importance of a solid relationship with technology developers and vendors as instrumental to effective use of health IT in underserved communities.
Integration of IT into a broader clinic and health system “The drive for policy change was that function is critical for sustainability. Respondents it [remote monitoring] get reimbursed emphasized the importance of incorporating health IT and that it get recognized as a tool… applications into the broader clinic and health system and that providers use it as a tool… function for sustainability. One telehealth case manager Now I think we’re moving in that explained, “Thank goodness our program is set up on a direction with the patient-centered system. Even though [the telehealth nurse] was out sick for a medical home. People are recognizing period of time, anyone can pick up the system and keep it you can’t just look at what is happening in the exam room, you have going. That’s where it comes into play to have more to look at the whole picture.” RCCHC legislative support on safety measures and really tight Administrator protocols for telemonitoring”
Because reductions in hospitalization represent an important financial benefit from clinic-based telehealth programs, respondents suggested this intervention offers an opportunity for the Accountable Care Organization (ACO) model where a consortium of providers share financial benefits for reducing costs, noting that under the model everyone that is an ACO partner is going to benefit.
Summary of Findings
This case study illustrates how the use of telehealth for monitoring of patients with chronic conditions results in increased patient engagement and self-management, and improvements in decision-making and the delivery of quality care for predominately rural minority populations. Stakeholders emphasized the importance of introducing telehealth technology to both patients and providers through a trusted source. They also noted the importance of customizing technology and programming it to meet the needs of providers and the patients they care for. Project Background and Data Sources The case demonstrates the importance of The Office of the National Coordinator for Health Information interoperability with other IT systems with Technology (ONC) and the Health Resources and Services respect to acceptance, utilization, and Administration (HRSA) awarded NORC at the University of Chicago a project to conduct case studies examining sustainability, and that limited telephone lessons learned from community organizations using health infrastructure limits access to telehealth. IT to serve the needs of underserved groups or to address Finally, the case study reinforces the health disparities. The final report from this project will importance of partnerships in enabling and inform the Secretary of the Department of Health and documenting program success, and the Human Services’ (HHS) work under these topics per Section potential importance of exploring use of 3001 of the Health Information Technology for Economic and Clinical Health (HITECH) Act passed as part of the telehealth reimbursement policies to support American Recovery and Reinvestment Act of 2009 (ARRA). FindingsCASE are STUDY: based Patient on analysis Provider of notesTelehealth taken Network during| a10 series of discussions with administrators, providers, and patients at RCCHC and Piedmont. NORC | Understanding the Impact of Health IT in Underserved Communities and those with Health Disparities clinic-based telehealth initiatives that can result in significant reductions in hospital-related costs.
i Britton, Bonnie. (2010). Aging in Place: Remote Monitoring and Chronic Care Management. Available: http://www.aging.unc.edu/nccoa/2010/presentations/Britton.pdf. ii Eastern North Carolina Community Takes Radical Approach to Fight Nation’s Top Two Health Problems. 2007. http://www.businesswire.com/news/home/20061002005197/en/Eastern-North-Carolina-Community-Takes-Radical-Approach iii Description of Selected ACA New Model of Care Provisions and Similar Initiatives Underway in North Carolina. Available: http://www.nciom.org/wp-content/uploads/2010/12/New-models-described.pdf. iv Agency for Healthcare Research and Quality (AHRQ). National healthcare disparities report. 2010. AHRQ Publication No. 11- 0005. Available at: http://www.ahrq.gov/qual/nhdr10/nhdr10.pdf. v American Telemedicine Association. 2009. Abstracts of Home Telehealth and Remote Monitoring Related Peer Review Articles. http://www.americantelemed.org/files/public/membergroups/hometelehealth/HomeTelehealth_Authors_Topics_Journals_Only% 20Peer%20Reviewed%20Abstracts_.pdf. vi Telehealth Alliance of Oregon. 2007. Benefits of Telehealth. http://www.jirwinconsulting.com/Benefits%20of%20Telemedicine.pdf. Updated: November 23, 2007. vii Britton. (2010) Aging in Place: Remote Monitoring and Chronic Care Management. viii Britton, Bonnie. (2010). Telehealth and Chronic Care Management: Reducing Hypertension. Available: http://www.encsn.org/quarterly_11.htm. ix Britton, Bonnie and K. Schwartz. (2011.) “Use of Telehealth to Improve Chronic Disease Management.” North Carolina Journal of Medicine Vol. 73, No. 3 (2011): 216-218. Available: http://www.ncmedicaljournal.com/wp- content/uploads/2011/05/72311-web.pdf. x Britton. (2010). Telehealth and Chronic Care Management: Reducing Hypertension. xi Britton. (2010). Aging in Place: Remote Monitoring and Chronic Care Management.
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